Staff of Florida Medical Clinic Charged With PIP Fraud

April 10, 2003

The Florida Department of Financial Services announced that a former Miami clinic owner and two of his medical staff were charged with fraudulently billing four insurance companies for treatments never provided.

Investigators with the Division of Insurance Fraud allege Juan Carlos Delgado, former owner of A&A Re-Establishment Medical Center in Hialeah, billed for treatments for six patients who were covered by personal injury protection (PIP) benefits totaling $37,000. Several patients provided statements that the treatments were never provided. In addition, one patient told investigators he was paid $1,000 to allow his insurance company to be billed for phony medical procedures. Delgado was charged with six counts of insurance fraud, six counts of grand theft and one count of organized scheme to defraud.

Also arrested and charged with insurance fraud were Dr. Ulises Pichardo and physician’s assistant Danilo Bravo who signed phony medical reports citing non-existing injuries. The two then submitted the reports in support of insurance claims filed by the clinic. Pichardo was charged with four counts of insurance fraud and four counts of grand theft. Bravo was charged with two counts each of insurance fraud and grand theft.

“The cost of fraudulent claims eventually gets passed on to consumers through increased premiums and increased costs for services,” said Chief Financial Officer Tom Gallagher.

It’s estimated that PIP fraud adds as much as $240 to the average family’s auto insurance premium each year. The Florida Legislature is currently debating legislation that would increase penalties for the solicitation of accident victims.

The Department of Financial Services, Division of Insurance Fraud, investigates various forms of fraud in insurance, including health, life, auto, property and workers’ compensation insurance. Anyone with information about this case or another possible fraud scheme should call the department’s Fraud Hotline at (800) 378-0445. A reward of up to $25,000 is offered for information leading to a conviction.

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